ELCID: early lung cancer identification and diagnosis - an embedded interview study to explore patient participation and recruitment

Background The ELCID Trial is a feasibility randomised controlled trial examining the effect on lung cancer diagnosis of giving an urgent chest x-ray to smokers, and recent exsmokers, aged over 60 with new chest symptoms. Aims The qualitative component explores the feasibility of individually randomising patients to an urgent CXR or not and investigates any barriers to patient participation. Methods To date we have conducted semi-structured interviews with six primary care staff (practice managers, research nurses), ten patients randomised to ‘extra-NICE’ guidelines for referral for urgent chest x-ray, and six patients randomised to ‘usual care’ (NICE guidelines)). We hope to also interview patients who decline randomisation. Interviews were analysed using a Framework approach. Results Initial analysis indicated that practices have struggled to recruit patients, partly due to the eligibility criteria that requires ex-smokers to have stopped smoking within the last five years. Practices with a research nurse have recruited the most patients. Patients indicated that they are happy to take part in the trial and their anxiety levels were not raised. Most patients hoped to be randomised to urgent chest x-ray, although those who were not did not go back to their GP to request one. Conclusions Eligibility criteria needed revision to include ex-smokers of any duration. These preliminary findings suggest that the trial appears to be feasible and patients are happy to accept randomisation. The findings will inform the design of the main trial in the future